2018 Sun Life Rates

Each year, the Sun Life Extended Health and Dental Care plans are reviewed with UBC’s Benefits Consultants to determine the appropriate premium rates to support claim costs expected for the upcoming year. Based on the review, it has been determined that there will be no change to the Extended Health and Dental Care plan premium rates for the 2018 calendar year.

The following tables outline no change to the Extended Health and Dental Care plan premium rates, effective January 1, 2018. The renewal rates are based on analyzing 12 months of past claims experience (July 1, 2016 – June 30, 2017) while incorporating ongoing inflation.

Dental Plan Current 2017 Monthly Rates New 2018 Monthly Rates
Effective Jan. 1, 2018
Adjustment
Single $45.81 $45.81 + 0%
Couple $91.91 $91.91 + 0%
Family $136.26 $136.26 + 0%
Extended Health Plan Current 2017 Monthly Rates New 2018 Monthly Rates
Effective Jan. 1, 2018
Adjustment
Plan 1 (LTM* $15,000)
Single $60.19 $60.19 + 0%
Couple $120.40 $120.40 + 0%
Family $120.40 $120.40 + 0%
Plan 2 (LTM* $50,000)
Single  $92.48 $92.48 + 0%
Couple $186.81 $186.81 + 0%
Family $186.81 $186.81 + 0%
Plan 3 (LTM* $200,000)
Single $63.75 $63.75 + 0%
Couple $127.53 $127.53 + 0%
Family $127.53 $127.53 + 0%

* LTM – Lifetime Maximum

Medical Services Plan Rate Changes

The Medical Services Plan (MSP) is the BC provincial government program that covers medically required services provided by physicians and supplementary health care practitioners, laboratory services and diagnostic procedures. In the fall, the BC Ministry of Health announced an updated calculation of MSP rates.

Effective January 1, 2018, current rates for MSP premiums will be reduced by 50% for all residents of British Columbia. There is no need to apply for this reduction as premium amounts will be automatically adjusted. The new MSP premium rate for one adult (with or without children) will be $37.50 per month and the premium rate for two adults (with or without children) will be $75.00 per
month.

Reminder: There are no MSP premiums charged for dependent children (under the age of 19 or between the ages of 19-25 if they are considered a full-time student).

 MSP Rates 2017 Monthly Premiums Monthly Premiums
Effective Jan. 1, 2018
One Adult $75.00 $37.50
Two Adults $150.00 $75.00

MSP Premium Assistance Program Rate Changes

The Medical Services Plan (MSP) threshold for those who are eligible for Premium Assistance continues to be available for those with a household combined adjusted net income of $42,000 or less. Full Regular Premium Assistance will be available to those whose adjusted net income is $26,000 or less. This is a $2,000 increase from the current $24,000. All other current rates for MSP Premium Assistance will be reduced by 50%.

If you believe you are eligible for Premium Assistance, you can apply by completing the MSP Application for Regular Premium Assistance form.

Please contact Janet McHugh at 604-822-4580 or janet.mchugh@ubc.ca if you need a form to be sent to you instead. If you are paying your MSP premiums through the RSB Plan, your Regular Premium Assistance form will need to be signed by Janet McHugh prior to being sent to Health Insurance BC for processing. Please send your completed form to:

Janet McHugh
600 – 6190 Agronomy Road
Vancouver, BC V6T 1Z3

Allianz Out-of-Country Claim Form

If you are enrolled in the Extended Health Plan and require emergency medical care while outside BC, you or someone with you must call Allianz Global Assistance before receiving medical care. As Sun Life’s travel benefits provider, Allianz will guarantee or advance payment for your medical care.

Seeking emergency care outside of BC

In Canada and the US, you can reach Allianz Global Assistance’s 24-hour operations centre toll-free at 1-800-511-4610. Elsewhere, make a collect call to 1-519-514-0351.

All invasive or investigative procedures (such as surgery, angiogram, MRIs) must be pre-approved by Allianz, except in extreme circumstances.

Submitting claims for emergency medical expenses

If you are submitting claims for services and supplies while in hospital, or for outpatient and physician’s services incurred outside of BC or Canada AND as a result of a medical emergency, Allianz will coordinate payment of your claim with the BC Medical Services Plan (MSP), the UBC plan and any other benefit plans you are covered by with Sun Life.

Please note: MSP will be the first payor in this circumstance. If you want to purchase additional travel coverage to protect your lifetime maximum or if you do not feel your lifetime maximum balance is sufficient coverage, you need to ensure your individual coverage will be the second payor for emergency medical expenses and not your Extended Health benefits.

To ensure you are properly reimbursed, keep all receipts and always obtain a fully itemized bill for any hospital treatment.

To submit a claim:

  • Within 30 days of your return home, complete the Allianz Emergency Medical Expense Claim Form.
  • Attach original receipts and make a copy of the entire claim for your records.
  • Mail your claim form to the appropriate address indicated on the form.

Note: There are some situations where it will be necessary for you to reimburse Sun Life.

Submitting claims for non-emergency medical expenses

To ensure you are properly reimbursed, keep all receipts and always obtain a fully itemized bill for any hospital treatment.

To submit a claim:

  • Submit a completed Extended Health Claim Form to Sun Life within 30 days of your return home.
  • In section 3, indicate your claim is for out-of-Canada expenses.
  • Attach original receipts and make a copy of the entire claim for your records.
  • Mail your claim form to the appropriate address indicated on the form.

Submitting claims for dental expenses

If you incur out-of-pocket emergency and non-emergency dental expenses while travelling outside BC or Canada, submit a Dental Care Claim Form to Sun Life when you return home.

If your claim was a result of a dental accident, complete the Allianz Emergency Medical Expense Claim Form within 30 days of your return home. Attach original receipts and make a copy of the entire claim for your records and mail it to the appropriate address indicated on the form.

Sun Life Provider Search and Rating Paramedical Providers

Learn about two useful tools offered by Sun Life to enhance your experience with healthcare providers.

Provider Search

Through Sun Life’s mobile app, you can access the Provider Search feature to find a professional who meets your healthcare needs. Provider Search allows you to:

  • View the provider’s rating from other Sun Life members
  • Locate providers who bill Sun Life directly (so that you do not have to pay first and submit a claim for reimbursement)
  • Call the provider directly to make an appointment
  • Add the provider to your contacts
  • Get directions to the clinic by launching the Maps app on your phone

To get started, download the Sun Life mobile app from Google Play or the App Store and click on ‘Provider Search’. To access Provider Search via your desktop computer, visit www.mysunlife.ca.

Paramedical Provider Ratings

Sun Life allows you or your family to rate paramedical providers when you submit a desktop e-claim on www.sunlife.ca. The responses empower plan members to take charge of their health and wellbeing. Since the launch of Sun Life’s healthcare provider ratings network, over one million ratings have been submitted. The paramedical services you rate are the same ones you can do a Provider Search for.

On the my Sun Life mobile app, you can rate both paramedical and dental providers when you submit a mobile e-claim.

A provider’s average rating is calculated based on ratings collected on mobile and web and is displayed immediately.

For more information, contact Sun Life directly at 1-800-361-6212.

Meet Ella, Sun Life’s New Digital Coach

Sun Life’s new digital coach is ready to help plan members navigate their online (and soon mobile) options in a personalized way.

Ella empowers plan members to better understand their needs and available options, so they can choose the best appropriate action. Through Ella, Sun Life is taking a proactive approach to supporting the financial health and wellbeing of plan members.

How does Ella work on www.mysunlife.ca?

As a digital coach, Ella will initially provide plan members with relevant information, insight and advice, and will evolve over time to be increasingly interactive. For example, Ella can prompt plan members with helpful messages, such as:

  • Reminding plan members that their son or daughter is turning 19 and will need their own healthcare coverage to replace
    their benefits coverage if they are not attending school full-time
  • Increasing plan member understanding of and participation in their plan through direct, relevant and timely information

Winter 2017 Reminders

Submit Your Extended Health Claims

Any extended health medical claims incurred in 2016 must be received by Sun Life by December 31, 2017.

To submit paper claims, download an Extended Health Claim Form or contact Janet McHugh at 604-822-4580 to have paper copies mailed to you. Remember to mail your completed extended health claim forms and original receipts to:

Sun Life (Waterloo)
PO Box 2010 Stn Waterloo
Waterloo, ON N2J 0A6

To submit e-claims, visit www.mysunlife.ca or access Sun Life’s mobile app.

2017 Tax Receipts

Every year, tax receipts are issued to retirees who pay their own extended health and/or dental premiums. The tax receipts will be mailed to you by February 28, 2018. Please only contact Janet McHugh about this if you do not receive the letter by March 15, 2018. Janet can be reached at 604-822-4580.

Allianz Global Assistance Telephone Number

In the US and Canada, call 1-800-511-4610.Elsewhere, call collect at 1-519-514-0351.

If you need to fax documents to Allianz Global Assistance, dial 1-519-514-0374.

Out-of-Province Travel Insurance

Canadians love to travel in Canada. And who can blame us? From hiking in the Rockies to whale-watching in Newfoundland, the options are nearly limitless.

If you love exploring our great country, there’s a good chance you’ve been forgetting to pack a very important item: travel insurance. You probably know you need it for trips to other countries, but did you know that travel insurance for Canadians is also a good idea for trips to other provinces?

What your provincial health care plan doesn’t cover

By and large, our health care system covers our medical needs without causing us financial hardships, so many of us believe we have
a national health care plan that protects us equally across the country. In fact, our health care expenses are covered by provincial health insurance plans – and the extent of that coverage differs from province to province. That means that while the provinces do cover some medical services for their residents while they’re elsewhere in the country, they may only pay the equivalent of what the
service would cost in the home province. So, if something costs less where you live than in the province where you’re visiting, your provincial health care plan may pay only part of a medical bill you might run up while you’re there. You could be responsible for the rest. What’s more, provincial plans won’t typically
pay for:

  • Air or ground ambulance transportation
  • Prescription drugs
  • Dental emergencies
  • Medical transportation to your home province

Without a private travel medical insurance policy, you will have to pay for these expenses out of your own pocket.

What non-medical travel insurance covers

Besides medical costs, you may run into expenses for other travel-related events, such as lost luggage, damaged items and trip
cancellation. There’s a type of private travel insurance called a “non-medical policy” that will reimburse you for these types of expenses. You can buy this coverage on its own, or as part of a package policy that includes medical coverage.

If you decide to take your vacation in Canada this year, remember that even though we use the same money everywhere, we don’t have the same health care coverage. If you visit another province, consider purchasing a travel
insurance policy.

For those enrolled in Extended Health benefits

You have emergency medical travel insurance included under your Extended Health benefits. Travel insurance is for medical emergencies only and does not include coverage for lost luggage or trip cancellation. Coverage is for up to 90 days per trip and reimbursement is at 100%.

You can obtain your Medi-Passport card for travel coverage information online at www.hr.ubc.ca/benefits/forms (click on
‘Retirement & Survivor Benefits Program’ link), or call Janet McHugh at 604-822-4580 to have a paper card mailed to you.

Please note: any claims you make for travel coverage go towards your lifetime maximum under the plan. To keep track of the balance remaining in your lifetime maximum (LTM) under your Sun Life Extended Health Care benefit, please contact Sun Life directly at 1-800-661-7334.

If you want to purchase additional travel coverage to protect your lifetime maximum or if you do not feel your lifetime maximum balance is sufficient coverage, you need to ensure your individual coverage will be the first payer for emergency medical expenses and not your Extended Health benefits through the Retirement & Survivor Benefits (RSB) plan.

Allianz Global Assistance Contact Numbers:

  • In the USA and Canada, call 1-800-511-4610
  • Elsewhere, call 1-519-514-0351 (call collect if available)
  • Fax documents to 1-519-514-0374

Additional Resources:

(Source: www.sunlife.ca)

Get Fraud Smart

Each year, an estimated $5 billion is lost in Canada to health care benefits fraud and abuse.

What is benefits fraud?

Benefits fraud is an intentional deception or misrepresentation, by an individual or entity, with respect to a claim that results in payment for an ineligible benefit under the benefit plan.

What is benefits abuse?

Benefits abuse occurs from practices that, although not usually considered fraudulent, are inconsistent with accepted, sound, medical, dental, or business practices. Examples of abuse include overtreatment, excessive billing, and billing for services that are not medically necessary.

Why do benefits fraud and benefits abuse matter to you?

Benefits fraud and benefits abuse can have a direct impact on your benefits coverage. When fraud and abuse occurs, coverage levels can be at risk because UBC is required to pay more for benefits coverage.

Here are some tips to help protect you against benefits fraud/abuse:

  • Keep your benefits information confidential. Your benefits information is valuable. Keep your drug card and certificate/member ID confidential and in a secure place.
  • Submit claims online whenever possible. Online claims submission and direct deposit is the most secure form of claims processing (using www.mysunlife.ca or Sun Life’s mobile app). Remember to keep your access ID and password confidential, even from your service provider.
  • Check your receipts. Ensure your receipts are correct and reflect the services you actually received. If your provider submits claims electronically for you, cross-check your copy of this information with the claim statement you get from Sun Life to confirm they both reflect what you actually received.
  • Never sign claims forms in advance. Sign one completed claim form at a time – never pre-sign blank forms.
  • Report suspicious activity. If you are suspicious of any activity or request from a service provider or medical equipment supplier – such as actions that provide little or no benefit to you but maximize payments to the provider or supplier based on your coverage – please call Sun Life’s Fraud Hotline, toll free at 1-888-882-2221. Your confidentiality will be protected.

Tips for Preventing Fraud

  • Know your plan. Understand the treatments, products, medications and services that are covered by your plan – and the limits that apply. Ask your professional health service provider any questions if you’re unclear about their specific services.
  • Don’t substitute products or services. If a service provider suggests substituting one covered product or service for something that isn’t covered, decline the offer. Examples can include a facial or spa services instead of a therapeutic massage, or teeth whitening instead of regular dental care.
  • Review Sun Life’s delisted providers list. Take the time to review Sun Life’s “delisted providers” list so that you don’t unknowingly use a delisted provider, which would result in your claim being declined.

To view the delisted providers, log onto www.mysunlife.ca or use the Sun Life mobile app. Select the message for delisted providers found on the left-hand side of the screen. You will need to ensure you have pop-up blockers turned off. This list is updated periodically.

Sun Life’s Role in Fighting Fraud

Sun Life has a comprehensive fraud prevention, detection and investigation program – with a team of professionals dedicated to these tasks. Sun Life sometimes finds it necessary to disallow claims from certain health care service providers, clinics, facilities or medical suppliers to better protect your plan. When Sun Life delists a provider, this means that they will not process or pay for claims from that provider.

If you have any questions regarding a provider, please contact Sun Life’s Fraud Hotline, toll free at 1-888-882-2221 directly.

Sun Life Launches Bright Minds Community

Bright Minds is a private online insights community made up of Sun Life plan members which allows Sun Life to create an ongoing dialogue with plan members and gain valuable feedback from them.

What plan members can expect:

  • At the end of May, Sun Life sent out an email invitation to plan members to the email address you used when setting up your online Sun Life account at www.mysunlife.ca.
  • Sun Life plan members who are interested will opt-in to join the community through the email invitation from Sun Life.
  • Participation is voluntary and Sun Life plan members can opt-out at any time.
  • Plan members’ participation in the community and any information they share with Sun Life will be treated with the strictest of confidence. Individual responses will not be identified and will be combined with those from other plan members in the community.
  • Community members will be given the opportunity to participate in a variety of engaging qualitative and quantitative research studies and be entered into periodic draws for prizes to thank them for participating.
  • Community members are encouraged to contact Sun Life (1-800-361-6212) should they have any questions or concerns.